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The draft report from the Department of Health and
Human Services' Agency for Healthcare Research and Quality focused
on a program designed to reduce the number of hospital-acquired
conditions (HACs). Andy Slavitt, the acting Centers for Medicare
& Medicaid Services administrator, announced the results of the
report at the CMS Quality Conference in Baltimore.

At the conference, acting CMS Principal Deputy
Administrator Patrick Conway announced that the agency awarded $110
million in funding for the end-stage renal disease (ESRD) care
improvements. Conway is also the deputy administrator for
innovation and quality at the CMS and serves as the agency's chief
medical officer.

Reasons for Improvement

A cumulative total of 2.1 million fewer HACs were
experienced by hospital patients in 2011, 2012, 2013 and 2014
relative to the number of HACs that would have occurred if rates
had remained steady at the 2010 level, which in turn drove down
Medicare's costs and saved lives, the report found.

One likely cause for the progress was that the CMS
created financial penalties for hospitals with higher HAC rates,
the report said. However, the reasons for progress on reducing HACs
aren't fully understood, according to the report.

In addition to the financial penalties, the report
cited public reporting of hospital-level results, technical
assistance offered by the Quality Improvement Organization program
to hospitals “and technical assistance and catalytic efforts” of
the HHS Partnership for Patients (PfP) initiative led by the
CMS.

A QIO is a group of health quality experts,
clinicians and consumers organized to improve the care delivered to
people in Medicare. Part of the mission for QIOs is protecting the
Medicare trust fund by ensuring that the program pays only for
services and goods that are reasonable and necessary and that are
provided in the most appropriate setting.

The HHS announced the PfP in April 2011 (71 HCDR,
4/13/11). At that time, the HHS said the program will bring
together stakeholders including hospitals, employers, consumer
advocates, health insurers and others to meet two primary goals by
the end of 2013: reduce preventable HACs by 40 percent and reduce
preventable hospital readmissions by 20 percent, compared with 2010
levels.

According to the report, the widespread
implementation and improved use of electronic health records at
hospitals likely contributed to the HAC reduction as well.

ESRD Funding

Following Conway's ESRD announcement, the CMS
published a blog posting authored by the deputy administrator with
further details on the dialysis funding.

In the blog posting, Conway said the CMS awarded
$110 million to fund seven entities within the 18 various ESRD
networks. A congressional mandate created the networks in 1978 as a
way to improve cost effectiveness, ensure quality of care,
encourage kidney transplantation and home dialysis and offer
assistance to ESRD beneficiaries and providers. According to
Conway's blog posting, ESRD beneficiaries make up less than 1
percent of the Medicare population, but account for 7.1 percent of
Medicare program spending.

“These seven entities will work over a five year
contract period, 2016 – 2020, to continue efforts in improving
quality of care and access to care for individuals with
irreversible kidney disease who require dialysis or transplantation
to sustain life,” Conway said. Moreover, ESRD networks’ quality
improvement activities will incorporate efforts to impact the
patient population by increasing pneumococcal and hepatitis B
vaccination rates in dialysis patients, reducing the use of
long-term catheters for vascular access and reducing
hospital-acquired infections, Conway said. Additionally, he said
the ESRD networks will work on pilot projects to increase
transplant referrals, increase home dialysis rates, improve quality
of life and reduce hospitalizations for people with ESRD.

During the 2013 through 2016 ESRD network contract
cycle, ESRD networks have seen great successes, according to the
blog posting. “These successes included leadership in Patient and
Family Engagement through learning and action network activities.
Additionally, ESRD Networks have moved arteriovenous fistula (AVF)
vascular access use to above 60 percent nationally,” Conway
said.

To contact the reporter on this story: Michael D.
Williamson in Washington at mwilliamson@bna.com

To contact the editor responsible for this story:
Nancy Simmons at nsimmons@bna.com

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